Keratitis patterns in patients with human immunodeficiency virus: A 10-year retrospective study

To investigate the relationship between human immunodeficiency virus (HIV) disease markers, types of keratitis, and sociodemographic factors.

This retrospective epidemiologic study examines HIV-positive patients diagnosed with keratitis over the past 10 years. A chart review was conducted to confirm diagnosis and extract key demographic data (sex, age at keratitis diagnosis, race, and zip codes) and disease metrics (type of keratitis, infectious organism, antimicrobials used, CD4 count, and antiretroviral therapy [ART] adherence). The distribution of keratitis types and infectious organisms was analyzed for associations with demographic and clinical data.

Among HIV-positive patients with infectious keratitis, herpes simplex virus (HSV) and varicella zoster virus (VZV) accounted for 71.4% of infections. The distribution of organisms differed significantly from a uniform distribution (P = 0.0036), indicating a predominance of HSV and VZV. For noninfectious cases of keratitis, CD4 count and ART adherence were both significantly associated with the presence of keratoconjunctivitis sicca (dry eye disease; P = 0.0067 and 0.0126, respectively). The Black race was also more likely to be observed in the dataset (P < 0.001). Despite no significant relationship being observed between median household income based on zip code case clustering and keratitis incidence, this relationship approached statistical significance (P = 0.1358).

HIV-positive patients with keratitis are most likely to be colonized by HSV or VZV in infectious cases. HIV infection and ART usage are associated with chronic inflammation that may be related to dry eye disease. Racial and socioeconomic disparities continue to influence access to care in patients with HIV.